- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,639.88 / $1,702.16 / $9,233.16
| Facility | | $1,639.88 | $1,702.16 | $9,233.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,639.88 / $1,702.16 / $2,075.80
| Professional | | $1,639.88 | $1,702.16 | $2,075.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.34 / $12.34 / $12.34
| Facility | | $12.34 | $12.34 | $12.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.42 / $12.34 / $12.34
| Professional | | $9.42 | $12.34 | $12.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,075.80 / $3,425.07 / $55,999.44
| Facility | | $2,075.80 | $3,425.07 | $55,999.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,283.38 / $2,906.12 / $38,500.83
| Professional | | $2,283.38 | $2,906.12 | $38,500.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,349.27 / $1,584.04 / $2,490.96
| Facility | | $1,349.27 | $1,584.04 | $2,490.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,334.86 / $2,981.34 / $10,005.36
| Professional | | $2,334.86 | $2,981.34 | $10,005.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $871.84 / $1,245.48 / $2,283.38
| Professional | | $871.84 | $1,245.48 | $2,283.38 |